Hale Goksever Celik, MD

Dr. Goksever Celik is an obstetrician and gynecologist, graduated from the medical school of the Hacettepe University in Ankara, and trained through Obstetrics and Gynecology fellowship at Dokuz Eylul University in Izmir. She has been a postdoctoral research fellow at Molecular Biology and Genetics at Istanbul University. She has been participating in several research especially interested in the association between endometriosis surgery and ovarian reserve and the genetic basis of endometriosis.

A scoping review proposal for the diagnostic and treatment delay of endometriosis

Women with endometriosis suffer from pain for a prolonged time due to diagnostic and treatment delay which is the most challenging aspect of endometriosis. Cromeens et al, from the USA, published a review entitled “Timing, delays, and pathways to the diagnosis of endometriosis: a scoping review protocol” in the journal named BMJ Open. The authors sought to develop a review protocol that will be a source for researchers who want to work on the diagnosis process of endometriosis. Methodologically, they wanted…

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Adenomyosis, fertility, and obstetric outcomes

Adenomyosis is the localization of endometrial glandular and stromal cells within the myometrial wall. Although magnetic resonance imaging has a higher ability to discriminate and identify adenomyosis, transvaginal ultrasonography is a cheaper, more accessible, and practical method in daily clinical practice for the diagnosis of adenomyosis. There is an association between adenomyosis and fertility and obstetric problems depending on various mechanisms such as impaired sperm transport-implantation, uterine dysperistalsis, and presence of high levels of free radicals in the uterine milieu, decreased uterine…

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Does exercise have an effect on pain perception in women with endometriosis?

Endometriosis is an inflammatory disease causing pain symptoms such as dysmenorrhea, dyspareunia, chronic pelvic pain, and also infertility. Several medical and surgical treatment options have been developed to improve quality of life of these women. Despite extensive research, the optimal management of endometriosis still remains unclear. Hansen et al., from Denmark, published a systematic review entitled “Impact of exercise on pain perception in women with endometriosis: A systematic review” in the journal named "Acta Obstetricia et Gynecologica Scandinavica". The authors…

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A pictorial overview of abdominal wall endometriosis

Abdominal wall endometriosis is the most frequent location of extrapelvic endometriosis, and defined as the presence of ectopic endometrial tissue between the peritoneum and the skin through the abdominal wall. Although obstetric or gynecologic surgical history is indispensable for the development of abdominal wall endometriosis, it can rarely be encountered in some women as primary, without any previous operations. The incidence of abdominal wall endometriosis is approximately 3.5% in patients having past gynecological surgery and 0.8% in those with a…

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Postoperative ovulation induction in infertile women with minimal to mild endometriosis

Infertility is an important problem that is encountered in 30-50% of women with endometriosis. Several etiopathogenetic mechanisms for the development of reproductive problems in women with endometriosis have been proposed including abnormal peritoneal microenvironment, ovarian dysfunction and/or decreased oocyte quality, impaired fertilization, and implantation. No consensus has yet been developed for the management of endometriosis-associated infertility. Ovulation induction may be recommended to patients with minimal to mild endometriosis following operative laparoscopy. Zhou et al, from China, published a randomized clinical…

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The higher the cyst fluid iron concentration, the more severe the pain symptom for endometrioma

Endometriosis usually is encountered in three different forms: superficial peritoneal endometriosis, ovarian cysts (endometrioma) and deep infiltrating endometriosis. Endometrioma can be identified as cystic lesions consisting of dark brown endometrial fluid and are sometimes referred to as "chocolate cysts." The presence of endometriomas indicates a more severe stage of endometriosis. Dr. Kobayashi group from Nara Medical University, Japan, recently published a study entitled “Relationship between Cyst Fluid Concentrations of Iron and Severity of Dysmenorrhea in Patients with Ovarian Endometrioma” in the…

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How to predict the complications after laparoscopic bowel resection in women with endometriosis

The endometriotic lesions infiltrating the bowel wall more than 5 mm. are called "deep infiltrating endometriosis". The patients having bowel involvement may have constipation, diarrhea, tenesmus, or rectal bleeding. Surgical management is the main treatment modality to provide benefits on pain, infertility, and digestive symptoms. There is still uncertainty about markers to be used for early diagnosis of complications that may be encountered during the postoperative period. Pécheux et al. from France published a study titled “Predictive value of 4th post-operative-day CRP…

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Progestin suppression for endometriosis before IVF

“Dienogest is a suitable and safe substitute for GnRHa pretreatment in endometriosis patients”, according to the Khalifa et al., from Egypt. Endometriosis is one of the leading reasons for infertility due to decreased oocyte/embryo quality, fertilizability, tubal function, and aberrant endometrial receptivity. In vitro fertilization (IVF) overcomes some mechanisms that lead to infertility in endometriosis patients including removal of oocytes from the toxic peritoneal environment, bypassing tubal factor, and improvement of endometrial receptivity. There are several IVF protocols that are preferred…

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Optimal management of infertility in endometriosis patients

Pelvic pain and infertility are the main symptoms of endometriosis patients. Although the pathophysiological mechanism for infertility is not clearly understood, there are several theories explaining decreased fertility potential in women with endometriosis. Ata and Telek, from Koc and Istanbul Universities of Istanbul, Turkey, recently published an opinion article entitled “Assisted reproductive technology for women with endometriosis, a clinically oriented review” in the journal named "Current Opinion in Obstetrics and Gynecology". The authors aimed to investigate the effect of endometriosis on assisted…

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Immune-mediated conditions and endometriosis in adolescents and adults

The most common presenting complaints of endometriosis are mainly pelvic pain and infertility, commonly in relation to the menstrual period. Affected women demand therapy for these symptoms. Immunologic diseases such as autoimmune and/or inflammatory diseases, allergies, asthma, previous mononucleosis infection, and chronic fatigue and/or fibromyalgia could be encountered in endometriosis patients due to underlying common etiopathogenetic mechanisms.  Shafrir et al, from the Brigham and Women’s Hospital and Boston Children’s Hospital, USA, published a prospective study titled “Co-occurrence of immune-mediated conditions…

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Postoperative treatment and pregnancy points to decreased recurrence risk for ovarian endometriosis

Endometriosis is a disease most frequently diagnosed in women of reproductive age and negatively affects the quality of life. The most common localization for endometriosis is ovaries with a prevalence of 17-44%. Laparoscopic ovarian cystectomy performed as excision or ablation has been accepted as the gold standard approach in these patients. Excision of all visible endometriotic lesions, and adhesiolysis are recommended to restore ovarian anatomy. However, postoperative recurrence can be encountered in women who underwent laparoscopic ovarian cystectomy despite excision of…

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Controlled use of bipolar cauterization as an alternative to endometrioma cystectomy

The main symptoms of endometriosis are dysmenorrhea, dyspareunia, chronic pelvic pain, and infertility. Ablation or coagulation of the cyst wall following laparoscopic drainage of endometrioma may be an alternative treatment for patients with pregnancy intention. Carbon dioxide, laser, and plasma energy and bipolar instruments could be used to achieve ablation. Endometrioma cystectomy may have a negative effect on ovarian function and may reduce the in vitro fertilization success. Chen et al., from the Assisted Reproduction Unitof Sir Run Run Shaw Hospital, School…

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“Advanced gynecological ultrasound” for women with suspected endometriosis

Different clinical forms of endometriosis such as superficial endometriosis, endometrioma, and deep infiltrating endometriosis are present. Although no specific diagnostic tool is available for endometriosis, clinical findings, physical examination and imaging including transvaginal ultrasound and MRI are helpful to determine the treatment and to counsel these patients. Menakaya et al., from Australia and New Zealand, published a study entitled “Awareness and utilisation of advanced gynaecological ultrasound in the preoperative work-up of women planning surgery for endometriosis: A survey of RANZCOG…

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Managing the physical and emotional effects of endometriosis

Endometriosis is known to affect 5-10% of the general population, but some women are underdiagnosed due to physical and psychological disability. Due to the symptoms including dysmenorrhea, dyspareunia, chronic pelvic pain and infertility, endometriosis has a negative effect on the quality of life. The social life of women with endometriosis is disrupted during their menstrual periods. As a result, the patients with endometriosis may also be stigmatized by their partners due to the experiences about the disease. The supportive approach of…

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Impaired fertility potential in endometriosis patients

Infertility is frequently encountered in endometriosis patients because of anatomic distortion, alterations in endometrial receptivity, diminished tubal peristalsis and sperm movements. Garcia-Fernandez and García-Velasco, from Edinburgh, UK and Madrid, Spain, published a mini-review titled “Endometriosis and Reproduction: What We Have Learned” in the "Yale Journal of Biology and Medicine". The authors aimed to evaluate all aspects of the relationship between endometriosis and infertility, and suggest preventive measures.  Even though disease stage and presence of endometrioma are negatively correlated with fertility,…

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Vitamin D supplementation, endometriosis symptoms and metabolic profiles

Patients with endometriosis suffer from dysmenorrhea, dyspareunia, chronic pelvic pain, and infertility. These women are also at higher risk for ovarian and breast cancer, cardiovascular events, and metabolic abnormalities. Several medical and surgical alternatives have been recommended to these patients to increase their quality of life and prevent associated morbidities. Vitamin D has been suggested for its ability to improve endometriosis-related immunological functions as it plays an important role in the regulation of immunologic mechanisms. To investigate the effect of…

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Self-management and the quality of life in women with endometriosis

Endometriosis symptoms can range from mild to severe. The most common presenting complaints are mainly pelvic pain and infertility. There is no doubt that the physical and mental quality of life of these women is adversely affected. There are several studies evaluating the quality of life in endometriosis patients in a hospital or clinic setting. However, the effect of self-management factors on physical and mental quality of life in a community setting has not been investigated. O’Hara et al,  from Australia,…

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Live Birth Rate in Women Who Underwent Fresh Embryo Transfer Using Freshly Retrieved Donor Oocytes

One of the important clinical findings in women with endometriosis is reproductive problems. Infertility can be encountered in up to 50% of women with endometriosis and up to 50% of women with infertility can be diagnosed with endometriosis. Several pathophysiologic mechanisms have been proposed for the development of infertility in endometriosis patients, such as anatomic distortion, alterations in endometrial receptivity, diminished tubal peristalsis, and sperm movements. Assisted reproduction technology is the most frequently preferred treatment approach in women having endometriosis.…

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Postoperative pregnancy rate in infertile women with deep infiltrating endometriosis

Deep infiltrating endometriosis (DIE) is fibrous/muscular infiltration of organs and anatomical structures containing endometrial tissue below the peritoneum regardless of the depth of infiltration. Another definition describes DIE as infiltration of the peritoneum by endometriotic lesions deeper than 5 mm. Pain, subfertility/infertility are the main clinical symptoms of these patients in whom surgical removal of all endometriotic lesions is required due to better outcomes in pain and fertility relief. To investigate the impact of surgeon’s experience on postoperative spontaneous pregnancy rate,…

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Implantation failure in endometriosis patients - Jovana Lekovich, MD., PhD.

Endometriosis is one of the leading reasons for infertility due to decreased oocyte/embryo quality, fertilization ability, tubal function, and aberrant endometrial receptivity. Whether this failure is caused by oocyte/embryo or eutopic endometrium is one of the investigated topics in endometriosis research. Although previous studies claimed that abnormal oocyte/embryo development results in infertility in endometriosis patients, it is known that the endometrium has an important role in the clinical pregnancy rate and live birth rate based on recent publications. When eutopic…

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